>> thank you, secretary clinton, for an inspiring, comprehensive, and wonderful speech. it made me proud to be an american and to be at georgetown, too. [laughter] the secretary has come for three questions. because so many of you have abandoned your final papers to be here, we felthought we would

take the questions from our students. we have several people along the side with microphones. here is somebody with a microphone. let's have a first question from a student. that does not look like a student. [laughter] let's get a young person. we are not discriminating. we just want a calm approach to things. >> you spoke about the situation in uganda. will you please talk to us a little bit more about how the united states can protect the rights of lgbt people in those areas where their rights are not respected? >> yes. first, let me say that, over this past year, we have elevated into our human rights dialogue and a public statements a very clear message about protecting the rights of the lgbt community

worldwide. we are particularly concerned about some of the specific cases that have come to our attention around the world. there have been no organized efforts to kill and maim gays and lesbians in some countries that we have spoken out about and also conveyed are very strong concerns about to their governments, not that they were governmentally implemented or even that the government was aware of them, but that the government's need to pay much greater attention to the kinds of abuses we have seen in iraq, for example. we're deeply concerned about some of the stories coming out of iran. in large measure and reaction, we think, in response to the

elections back in june, there have been abuses committed within the detention facilities and elsewhere. and then the example that i use of a piece of legislation in uganda which would not only criminalize homosexuality but apply the death penalty to it, we have expressed our concerns directly, indirectly, and we will continue to do so. the bill has not gone through the ugandan legislature. but it has a lot of public support by various groups, including religious leaders in uganda. we view it as a very serious potential violation of human rights. it is clear that, across the world, this is a new frontier in the minds of many people, how we protect the lgbt community. but it is at the top of their lives because we see many

instances where there is a very serious assault on the physical safety and an increasing effort to marginalize people. we think it is important for the united states to stand against that and to enlist others to join us in doing so. >> thank you so much for being here you brought up iran today. i am. -- i m on iranian american. to witness what happened after the election was an incredible moment in history. what can the united states do to balance our support of the human rights activists and demonstrators in the streets of teheran? how do we balance those issues? >> it is a balancing act.

the most important is to make sure that our very strong opposition to what is going on inside iran does not, in any way, undermine the legitimacy of the protest movement that has taken hold. this is one of those very good examples of a hard call. after the election and the reaction that began almost immediately by people who felt that the election was invalid put us in the position of seriously considering what is the best way we can support those who are putting their lives online by going to the streets? we wanted to convey clear support, but we did not want the attention shifted from the legitimate concerns to the united states. we had nothing to do with the spontaneous reaction that grew

up in response to the behavior of the iranian government. so it has been a delicate walk. the activists inside know that we support them. we have encouraged their continuing communication of what is going on inside iran. one of the calls that we made shortly after the election in the midst of the demonstrations is a unit of these very technology savvy young people that we created inside the state department and they knew that there was a lot of communication about demonstrations and sharing information on twitter. totally unconnected to what was gone on in iran, twitter had planned some kind of lapse in service to do something on their system. i have no idea what they're doing. you can tell. [laughter] i do not know quarter from tweeter -- i do not know twitter

from tweeter. [laughter] we told them, do not take down twitter right now. people in iran are dependent upon twitter. we have done that careful balancing. clearly, we think that pursuing an agenda of non-proliferation is a human rights issue. what would be worse than nuclear material or a nuclear weapon being in the hands of either a state or in non-state after that would be used to intimidate and threaten and even, in the worst- case scenario, destroy? we see a continuum. pursuing what we think is in the national security interest of not only the united states, but countries in europe and the middle east and it is a human rights issue.

we do not want to be in an either/or position. are we going to pursue non- proliferation with iran or are we going to support advocates in iran? we want to do both. >> i am wondering what you see the role of artists is doing in helping to promote human rights. i had the privilege to hear the playwright speak in one of the senate buildings after she advocated for women's rights in

the condo. i wonder how you secretive practice accompanying an amplifying policy -- i wonder how you see creative practice accompanying an amplifying policy. >> that is a wonderful question. the arts and artists are one of our more effective tools to reach beyond and through repressive regimes and giving hope to people. it was a very effective tool during the cold war. i have had so many eastern europeans tell me that it was american music, it was american literature, it was american poetry that kept them going. i remember one also hobbled came to the white house and we were having a state dinner for him. i asked him who would like to entertain at the state dinner? i did not know what he was going to say. he said the lead.

-- he said lou reed. [laughter] he said it was important to them in prison and out of prison. we are going to try to increase the number of artistic exchanges we do so that we can get people into settings where they will be able to directly communicate. with communication being what it is today, you can download them and all the rest, there's something about the american government sending somebody to make that case, which i think it's very important to our commitment. also, artists can bring to light in gripping and dramatic ways to the challenges we face the mentioned the plan about women in the condo. -- we face. you mentioned the play about women in the condo.

-- in the congo. i think that artists, individually and through their work, can illustrate better than any speech i can give or any government policy we can promulgate that the spirit that lives within each of us, the right to live and dream and expand our boundaries, it is not confined. no matter how hard they try, by any regime anywhere in the world, there is no way that you can deprive people from feeling those strings inside their souls. artists can give voice to that. they can give shape and movement into it. it is so important -- it is so important in places where people feel forgotten and marginalized and depressed and hopeless, to have that clear that there is a better future, that there is a better way, that they just have to hold onto.

so i am going to do what i can to continue to increase and enhance our artistic out to reach. but this is also a great area for private foundations or ngo's, for artists themselves and universities like georgetown to be engaged in. in today's world, we are deluged with so much information. we are living in information overload times. we need ways of cutting through all of that. we are also living in the media and garment. i always joke that, it's a television station or a newspaper interviews somebody who is claiming that the earth is round, they have to put on somebody from the flat earth society because that is a balance, fair and balanced.

[laughter] hope [applause] we have to look for those ways of breaking through all of that. i think the power of the arts to do that is so enormous and we cannot ever forget of the world that it must play in giving life -- of the role that it must play in getting live to the aspirations of the people around the world. thank you very much. [applause]

>> can i ask you to remain seated while secretary clinton departs? >> in his weekly online address, president obama spoke about a connection between an al qaeda group and a plan bombing on a u.s. jet. mitch mcconnell talks about the domestic and foreign policy

challenges that lie ahead for the nation and the need for elected leaders to come together to solve these problems. >> it has now been more than a week since the attempted act of terrorism aboard the flight bound for detroit on christmas day. i received the preliminary findings of the review that i ordered into our terrorist watch system. as i said this week, i will do everything in my power to make sure our hard-working men and women and intelligence, law enforcement, and security committees have the tools they need to keep america statesafe. the investigation into the christmas day incident continues. we're learning more about the

suspect. we know that he traveled to yemen, a country grappling with poverty. we know that this group and all canada in the iranian peninsula trained him -- and al qaeda in the arabian peninsula trained him. in recent -- and al qaeda in th e iranian peninsula trained him. even before christmas day, we have seen the results. training camps have been struck and leaders eliminated. all those involved in the attempted attack on christmas, they must know, you, too, will be held on account.

with my oath came the solemn responsibility that i carry with me every moment of every day, the responsibility to protect the safety and security of the american people. on that day, i also made a clear path our nation is at war with [unintelligible] we will do whatever it takes to defeat them, even as leopold the values that has always distinguished america among nations. make no mistake. that is exactly what we have been doing. that is why i have refocused the fight to end the war in iraq that has nothing to do with attacks of 9/11. . that is why i set a clear mission to disrupt, dismantle, and the ft al qaeda and its extremist allies. and it is why we have forged new partnerships and put unrelenting

pressure on these extremists where they plot. although often out of sight, our progress has been unmistakable. we have instructed terrorist financing, cut off recruiting change, and inflicted major losses on al qaeda leadership, flaafforded. the hard work of protecting our nation is never done as the review continues, let us ask the questions that need to be asked, let us make the changes that need to be made, let us debate the the best way to protect the country we all love. that is the right and responsibility of every american and every elected official. as we go forward, our adversaries are those who would attack our country, not our

fellow americans, not each other. let us never forget what has carried us through times of trial, including those attacks eight septembers ago. instead of giving into fear and cynicism, let's review that time as american spirit of resolve and confidence and optimism. instead of succumbing to partisanship and a division, let's sum and the unity that this moment demands. let's work together with seriousness and purpose to do what needs to be done to keep our country safe. as we begin this new year, i cannot imagine a more fitting resolution to guide us as a people and as a nation. happy new year. >> this is senator mitch mcconnell of kentucky. in 1777, along the new jersey-

pennsylvania border, a new continental army had finished a daring and successful surprise attack on the british at trenton. in retaliation, the british wants to attack of its own on the continental army. instead of retreating, washington ordered his troops to stay and fight. it was a daring move. when the soldiers on the continental army saw the size and strength of the army against it, many were filled with dread. even in that awful moment, these men had a sense of their own strength, of confidence in one another, and a feeling that province was with them that night. against impossible odds, these ragtag patriots broke the enemy column, forcing the british to retreat. at a moment of victory, the entire continental line is said to have triumphantly chatted as one. the second battle of trenton was a great victory for washington

strips and it was a great moral victory for a young nation that had become exhausted and discouraged by war. two hundred 33 years later, americans have not lost the spirit of trenton. two long and difficult course, a prolonged recession, double- digit unemployment, these are difficult days for our nation. in this new year, we are grateful for the courageous men and women of our own day who keep a lonely watch to defend the cause of liberty. we're also painfully aware of how many americans are out of work this christmas. but these challenges do not define us as a people. what has always defined america it is its ability to overcome even the most daunting difficulties. in this new year, we can be filled with new hope and optimism that are british challengers will be met, that better days are ahead, and that, in these difficult times, we will persevere as we always have, not just for our own

individual good, but for the good of all our countrymen. we believe that, for those to whom much is given, much as expected. some look at washington and wonder how lawmakers who always seem to disagree can solve any of our problems. while we approach the issues differently, at the beginning of a new year, it is important to remember that we are all united by our love of country and by a common faith that no challenge is too great for the american people to overcome. political disagreements will continue in the year ahead. this is an essential part of any vibrant democracy. but americans expect and deserve their elected leaders to put country first and work together to solve our common problems. powerful forces may be aligned against us, just as they did against the continental army on that cold january night in 1777. but the challenges are the greatest, americans always join

ranks. it was true in trenton. it is no less today. thank you and happy new year. >> coming up, a debate on health-care policy. there's also two interviews from c-span's documentary on the supreme court. following that, a look at the 2010 key senate races and the importance of polling in politics. >> tomorrow, at international affairs professor looks at the obama administration next steps for dealing with a record there is a political preview for 2010. and daniel erickson will look at u.s.-cuba relations. "washington journal" is live at

7:00 a.m. eastern on c-span. >> american icons, three original documentaries from c- span are now available on dvd. it is a unique journey through the iconic homes of the three branches of american government. see the exquisite detail of the supreme court, go beyond the velvet ropes of public tours of the white house, america's most famous song, and explore the history, art, and architecture of the capital. american icons is a three- disc dvd said. it is one of the many items available on c-span.org/store. >> now there is a debate on health care from a conference hosted by the university of virginia. this is about an hour and 25 minutes.

today, we turn to our attention in order and export policies and associated it tends to help health-care expenditures and [unintelligible] we will continue our wide- ranging discussion and i want to remind the audience and the participants of a few ground rules. first, the presentations are designed to be short to facilitate discussion among panelists and with the audience. when the moderator decides it is time to on the floor to question and answer, those of you who have questions, please go to the back of their room.

you have an opportunity to ask your question. second, if you have sophos, blackberrys, iphones, anything electronic other than a pacemaker, please turn it all. the signals from those interfere with air tv, microphones, etc. is it with our -- with our tv, microphones, etc. new spac. our panelists include thomas rice, the vice chancellor of academic personnel at the university of california los angeles. jonathan skinner is the john sloan dickey third century prof. of economics at dartmouth.

our third panelist is eric but passionate, the associate dean at the school of leadership and public affairs. our moderator for this panel and the next is alan murray. >> thank you. >we will have a discussion among us and then we will open the floor to all of you and tom is going first. >> thank you very much. i am delighted to be here. i am glad that we're talking about health-care costs. that is an important part of our

debt, the focus of the conference. i will be focusing on what factors are, in my opinion, for the quickly growing health-care costs in the united states. i have only two slides. the first one shows you how much of an out liar the united states is with regard to health-care costs. you might think we spend a lot because we are rich. that is not the case. on the vertical axis is how much the country spends per person on health care. on the horizontal axis is how rich the country is. if you put a line between the two, you find that the variable explains how much every country spends on health care with one exception, the united states. the u.s. spends about twice as much per person as other countries do on health care.

if you look at number two, switzerland, we are 56% higher than the swiss. why're costs higher here? that is what i will be focusing on. there are many factors, economic, political, historical -- it is hard to come up with a short list. i have come up with a list of four reasons. the lack of consolidation, of purchasing power, industrialization, paying for unnecessary care, and fee-for-service medicine. to understand lack of consolidation of purchasing power, think of canada. there's only one buyer of care in canada.

it is a monopoly on the buying side. they have tremendous power in the negotiations with hospitals and doctors and pharmaceutical companies. they did not always had this. in the 1960's, they were like the united states. they spent more than we did on hospital and physician care. since that time, since they consolidated and had the government get involved, their growth rates and the costs have been much lower than the u.s. costs. but that is probably not a good model for the u.s.. i do not think the insurance companies are going anywhere. we need to look at a mall that involves insurers. there are many models that are good examples. one would be france. france has multiple ensures, but the government does the negotiating and the coordinating of the prices of that they paid to hospitals, doctors, and

pharmaceutical companies. germany does not even use government. it has a consortium of insurers to do their own bargaining and then they pass up, and reads to providers. to me, -- and then they pay out, and rates to providers -- and then they pay out common rates to providers. i should mention the safety valve. some can get supplemental coverage which is necessary for political stability although it takes away from the equity of some of the systems. there are some other event inches for this coordinating of buying. one is that providers do not have an incentive to choose one

patient over another. right now, medicaid patients are not worth much so doctors to not want to treat them. that is not true under a system like this. also there is no opportunity to cost shift. everybody is paying the right amount for their patients. one player does not take the advantage of another pair. -- one pay youor does not take advantage of another payor. we rely on private insurers competition for medicare, it is not as effective as the va which does take advantage of its buying power. for-profit insurance does lead

to higher health-care costs. they have to make a profit. in addition, they engage in marketing. they also engage in medical underwriting they have to hire a lot of actuaries to make sure that they're not taking on people who are too expensive. these are all very costly things. it raises the price of private insurance. they do not have as much bargaining power so they can keep their prices low, like taking advantage of consolidated power. then why do we allow private insurers to have equality monopoly? there is no reason to think that savings would be transferred to the public. nonprofit insurance. -- what you really need is nonprofit insurance. let me just end with a few thoughts on how health care reform -- as you know, congress

does very little to control health-care costs. that is probably a reasonable short-term strategy. the proposals do nothing to consolidate purchasing power. the caveat is the public auction. -- the public plan. they do well with the proliferation of medical technology. they do very little to get doctors in primary care. there are some nice things in the bill that talk about moving toward accountable care organizations, bundling payments, not paying for unnecessary care, giving incentives for better care. if this will probably start with rocky road to get from the research evidence to wholesale changes in the system. we will lead to much to control

costs. but i do not think this is -- one more thing i wanted to mention is that we could have more research on comparative effectiveness, what works and what does not. when congress gave about $1 billion for comparative effectiveness research, it said that we cannot look at the cost. it'll look at the benefits. this is something that my colleagues in britain and australia looked at as nonsensical. how will we see the most cost- effective thing is if we cannot look at the cost? it was a political decision that congress made. it will stymie as as we go forward. why do i think that putting cost aside know may be a good idea? you really cannot talk too much about cost control.

every dollar of cost you say it is a dollar of income that you are taking away from someone. you try to put in a political constituency. that is not the way to do it. in 1965, medicare was a christmas tree in the beginning. that was how they got the legislation passed. then they started putting on restrictions. in fact, now everyone is so scared because medicare pays so little that we cannot use it as a model because it is too stingy in its payments. we did put in their cost controls later. medicare does have its financial problems, however. i think the public plan would have had the potential to control cost. it could sell insurance less than private insurers do. it would garner market share. it could allow for consolidated purchasing power to reduce

costs, which would bring more costs there. it does look like we will have much of a public plan, but but that's -- public plan, but that has the one potential for controlling costs. to end on a positive note, as we move toward universal coverage, we will create a system that will be more valuable to the changes we want to see with regard to cost containment. if we can get everybody under the same umbrella and one -- same umbrella and one system, we would have a great possibility of controlling costs. >> when you talk about consolidated purchasing power, you're talking about a system of price controls or something very close to price controls. we know that can lower cost. but what would the effect of the on innovation, on quality of

care, etc. >> we have a nice natural experiment. almost all of the countries do exactly what you're saying. let's take the case of germany. its system spends far less than we do. their medical outcomes appear to be better than ours. and they do not have to wait for services. waiting time for services in germany is a little bit lower than the united states. other countries, france, also have excellent outcomes. i don't think that you will necessarily be sacrificing quality. there is a survey of six countries. and they have right the to the country is among six different elements. the u.s. comes in last altogether. it comes in last and most of the six elements in terms of

quality. canada came in fits. it is the european countries that tend to do better. -- ken and it came in fifth -- canada came in fifth. it is the european countries that tend to do better. >> i am delighted to be back. the university of virginia give me my first job. it is nice to see students here also. i am going to talk a little bit about the quantity side. tom talked about getting the

price is right, which is what economists like to talk about but i am also going to talk about quantity, how much health care we getting? is it the right amount? there may be different solutions to getting the quality right. prices matter, but they may not be -- there may be other ways to get there. first of all, if you talk to most economists and u.s. quietest health-care costs and growing so rapidly, why are health-care costs in periling the fiscal soundness of the united states government going forward to the next 20 years or 30 years? they will give you one answer, technology growth. it gives us good things, but it also costs more money. but my usual response, to go back to an earlier debate about gun control were a people used to say that guns don't kill people, people kill people, i will try to convince you that it

is not technology growth. it is the people that use the technology, the rate of diffusion across the population that really affects the growth in health-care spending. there are different regions in the united states and different countries in the world that have dealt very differently with that kind of growth. i will show you some pictures. this is one from an earlier poll that shows regions in the united states. it shows the change over time and the spending between 1992 and 2006. these are adjusted for inflation. what you see first is the orange curve at the top, miami. it started high and it grew at a faster rate.

but san francisco is kind of the yellowish color. their growth rate was only two 0.4% per capita during this time. compare that to the 3.5% growth rate of the national average. the idea is that, if we can figure out what it is that san diego does -- that san francisco does, even that dallas does that the rest of the country has done in restraining growth, we could get medicare back on an even keel for the next few decades. if you run the numbers out, if you say, ok, san francisco, two 0.4%, united states, 3.5%, that is a difference of 1.9%. either the wonders or harness of compound interest, it is the difference you can see between current projections, the blue

line for the medicare dead versus the slotwing of growth to 1.1%. this has been done. we have to learn on how they do it and provide incentives to do it. right now, medicare has no incentives. they will pay for anything that does not kill you. second, it gets back to something that herb stein eustace said. he used a teacher for a couple of years -- but herb stein used to say. he used to be a teacher for a couple of years here. the current projections will account for more than 100% of

gdp in if they grow at the same rates within 75 years. that is clearly not something that is going to happen. but we can look to other countries to see what has happened. different countries have dealt with technology growth in different ways. but makes plenty what this number is. the number on the left-hand side is the change in spending on health care as a percentage gdp. u.s.'s at the rate at 7%. in 1980, u.s. health care spending was 9% of gdp. in 2007, of the spending was 17% of gdp. in sweden and denmark, the have not had growth -- they have not

had growth, not even 1%. that is sustainable. why them and not the u.s.? this is a scatter diagram changeover timing gdp -- this is a scattered diagram. setothe key is that sweden and denmark started with a very high tax rate in the 1980's. you cannot raise taxes much beyond 42% of the economy. it gets very inefficient. there are natural limits on how much you can spend on health care. it is an unfortunate way to do it. i think everybody recognizes that, in order to feed health care, you have to raise taxes.

there's really no other way. sooner or later, we will reach limits, which the united states is not comfortable with. the third point is that there's a lot of inefficiency on health care. here is a map of the dartmouth at less referral regions. there is a lot of money going on. if you count out the last time differences in medicare expenditures between los angeles and minneapolis, you end up with a really nice car. [laughter] it is on the order of $80,000.

it is yellow. the talents would never drive a yellow ferrari. -- the italians would never drive a yellow ferrari. parts of this money could go back to the citizens of los angeles or it could go back to the government. you can see that each got corresponds to one of the regions in the united states, the sort of like a histogram. you see rates per thousand. it is way up there. it is all area, ohio. they really like to do [unintelligible]

no one knew. the dartmouth that less identify these folks. there is a lot of savings potential. you would not pick it up with comparative effectiveness in less used in monitoring quantities and what doctors did in different regions. it is the doctors that the side, not some panel in washington, not some insurance company. the idea is that the doctor- hospital groups are paid on the basis of how well they restrain growth and cost. this is the scenario we would like to have played out, rather than rules from above, that the physicians in these groups get together and they say, wait a minute, i hear her sentries are really high. the internal medicine doctors go down to the cardiologists and

said, what is going on here? your rates are the highest in the country. why is that? let's try to get the costs down it would work internally. that is the way i would like to see the direction of health care reform. >> one question that comment in his comments -- d you see anything in the current bills in the house and the senate that will deal much with the problems you just outlined here? >> i agree with him. they're trying to set up a framework for these kinds of organizations. the language is actually in the legislature. but, in some cases, their pilots that are necessary because we do not know -- they are pilots that are necessary because we do not know how to roll them out across the country. >> there's not much there, but is a good first step and maybe incremental or small steps.

>> in the short term, i get the price is right. in the long term, restructure the way that health care is practiced so that people are more integrated groups. >> the rapid increase in per capita spending in the united states would be much worrisome if we thought every dollar were contributing to better expectations. wasteful spending persists in part because we do not have good mechanisms for identifying it. the system often adopts the more sophisticated tests and treatments and technologies, even if there is no objective or scientific evidence that they are better than available alternatives. congress and the obama administration has supported increased spending on comparative research to generate reliable information on what works best for what patient. the hope is that better information will help reduce

cost and quality. other nations already use such information to some degree but as the recent controversy over the mammogram, the trivial, efforts to use medical evidence to alter treatment can develop a political firestorm. what does the general public believe about medical evidence? this is a new issue in the debate. we do not know how much ordinary citizens think about it. will the [unintelligible] water people's biggest fears and concerns about this -- what are people's biggest fears and concerns about this initiative? alan gerber -- i recently conducted a public opinion survey. i want to share some preliminary results with you today. they are subject to revision. but we think they are sharp and

unambiguous enough that we feel confident sharing them. first of all, the public expresses some support for the concept of [unintelligible] but it is clear that it does not fully understand this problem. large majorities of the public believe that the research will lead be useuseful. lots of groups in society, almost everybody is worried about this. but the ones that are the most fearful are republicans and senior citizens. they are particularly susceptiblskeptical. if we ask people who should be deciding? the public has the most trust in the panel of doctors and citizens and the least trust in an independent government agency. the public believes that new

treatments are better than old ones. but there seems to be some support or willingness to accept cheaper treatment if their doctor recommends it. if we ask people, do you think it is ok for medicare to pay for new treatments and technologies only if they provide better results, you will get a large majority that say is a good idea. medicare should only spend money if it is better. but if you ask them this -- hard evidence is often unavailable for what evidence works better for certain patients. only 40% of the public thinks that this is almost completely accurate. there is lack of understanding of this problem. 41% of the public either says it is mostly or completely

inaccurate. if we begin to give the public some of the reasons above comparative research, we see advocacy groups and others trying to press these arguments. we want to test which ones resinated must with the general public. some of the arguments makinmade against research has a lot of traction with the public. one is that the research will not be useful because medical studies focus on the average patient and every patient is different. people feel that they are individual and these studies are not really going to be useful for them. there is some of the variants. everyone has their own health history. these treatment guidelines are not good to keep up with the pace of medical innovation and not reflect the latest scientific breakthroughs. somehow, they will be obsolete as soon as they are formulated.

73% of the public believes that. we're beginning to see some of the fears that the public has. the government and private insurers will use research findings to influence decisions about treatment, interfering in the relationship between doctors and patients. it is clear that americans care deeply about having a personal relationship with their own physician. the majority of democratic voters have this concern. republicans who agree strongly or somewhat is a very high percentage as well as independents. another fear is this idea that some outside entity is going to come between doctors and patients and make treatment decisions. democrats to their find this very convincing, but republicans and independents do so in stronger numbers. if you look by age group, we see the same kind of concern about

an outside group interfering with this relationship among all age kids, but especially seniors. 67% find in this is a convincing reason to be concerned. the government and insurance companies will use the findings for comparative research to ration care as happened in the united kingdom. that is a concern throughout the political spectrum. republicans and independents are more concerned than democrats. we gave people a list of possible entities that could be making these decisions over whether treatments and technology provide better results. we gave them a range of possibilities. you can see that the group that people trust the most are a panel of doctors and citizens, university sciences did not fare

as well, the commission of business leaders did very poorly, and an independent government agency, only 3% and the mesh trash. >> what you think happens when the panel of doctors and citizens are impaneled and impaired by a government agency? [laughter] -- are in paneled and empowered by a government agency? [laughter] >> good and question. we pressed to this one. if you look at the breakdown of demographic groups, how people rate those who have the least trust in government agency, that is 39% of overall respondents. 19% of democrats, 63% of republicans. part of what is in public

opinion, this is something new that political scientists have not spent a lot of time surveying about. we're trying to see how americans think about the health care system. people think that health care is getting better and that new treatments are more effective than those that were introduced 10 years or 20 years ago. a large majority believe that, especially seniors. if a doctor tells you that there were two equally efficient treatments without financial impact for the patient, would you still prefer the more expensive one? there are two treatments. one is more expensive and one is more cheap. the doctor says it is the same. your insurance is going to pay for it. would you like the more expensive?

the answer buried. more important where doctors me beating the cost of treatment. >> -- doctors mediating the cost of treatment. >> i would still watch what they do and not what they say. >> trying to probe how americans think about the health care system, 55% of the public, 59% of seniors, and, remarkably, they believe that modern marriage -- that modern medicine can cure [unintelligible] we believe in america that medicine can keep us yen, can keep us healthy, can keep us alive to a very large extent. 64% of the public believe that medicare is the most important reason that people live longer today.

is it better health, better but many people think it is medical care. i don't know that they are right about that. [laughter] if you asked a lot of health economists and experts about why health care is so expensive, you would come back to the fee- for-service system and the fact that provider of specialty groups and others, while their care for their patience, they try to maintain their income. .

>> i think that the three of you have made a very compelling demonstration that the current system, if you can call it that, in the united states is unsustainable. the status quo is not an option. it feels to me like we are in the middle of a great debate in this country about how to move forward on health care. one option is what you laid out, if not a single payer system, something that is like a single payer system and the purchaser uses comparative effectiveness training to decide which treatments to pay for and which ones not to pay for.

the other direction is, can we do in the health-care area what we have successfully done in other areas of our economy and create a functioning market place where consumers have bundled care and can look at comparative effectiveness studies. create some sort of a system where choice works to keep cost down and quality up. if the government is making choices for them, they are going to get stiffed. i would like to ask all three of you to comment on that. nobody else is taking the market model, but americans have great faith in the market. they have seen it work to their

benefit. i will let you go first, john. [unintelligible] well done, to shape. >> -- touche. >> we should think whether it should try to make something -- a brilliant surgeon writes for the new yorker and said that if you look at health care reform in other countries, they often draw -- they do not come up with something new, they draw off of their existing structure. i think that people find it difficult to make market-based

decisions when deciding what type of treatment to get. i saw this when i got a call from a vet about my cat about whether i wanted to spend $600 on an operation that had a one- third chance of success. this cat does not even like me and i had to make the call. imagine making those kinds of decisions about family members. i do not know how to do it. i do believe that i like a system where everybody gets a voucher for their own insurance plan. they can choose whatever plan they want. it is single payer, but it is not a single provider. if i want an insurance plan that tells me that they are not going to pay $30,000 for that treatment for pancreatic cancer

that extends your life for two weeks. your premium will be less. i would sign up for that kind of plan. >> does anyone else use that sort of system? >> i do not think so. the use other methods. this is new and different and it is not exactly the way other countries do it. >> but it is an american, market-based conclusion. i take it that you would not agree with that. >> we rationed, in our country, and this is consistent with what john was getting to, if he could get a better policy, he would choose not to get it. i think people do rationing on

the supply side. that means they do not have as many specialists available. they do not use technology as much. bay ration medical necessity than the ability to pay. -- the russian medical necessity rather than the ability to pay -- the ration medical necessity rather than the ability to pay. i was in favor of the independent government commission. >> you were part of the 3%. >> the distrust in government is not new in the united states, but it is given -- getting even graver. >> i talked about how consolidating market power would be a way to control costs. i do not think that that works

for a well, here. i can give an example. that is medicare drug benefit. it gives people tremendous amount of choice. most people have about 50 different choices. if you have tried to do it yourself or a parent, you can see how very difficult it is. i have tried to do that with a parent. it does not work out very well. it is hard to figure out among 50 plans which is the best for you. the programs are cheaper than expected. what has happened is that when people make a choice one year, they do not change to another plan in subsequent years. research has shown that people could save a lot of money if they switch. most people are in the wrong

plan for themselves. of those debts which could play $500 a year. when you give people a lot of choice and they do not have the information and they do not have the expertise, they end up making bad choices. >> it sounded to me like you were -- in other words, the choices have to be fairly simple and managed. if there are 50 or 100 different choices, you have a problem on your hands. >> i think that his point is well taken. people can get very confused. health insurance is a very complex product. >> i know that these are new results and you have only had a little bit of time to assimilate them, but what do they tell you about how to solve a grand comic ideological debate on how to move forward on health care? >> there are two ways to

control health-care costs. at the system level or at the individual level. the problem that we have is that we have been unable to make either choice. we have delegated to positions and providers that they are the experts. they should tell us what health care we need. the problem is that what we are finding is that physicians are not very good at controlling costs. they usually do not have the information to determine what is best. >> part of the reason is because we are greatly divided. i wonder if your results help us get to answer? >> i think that what they show is that there is tremendous distrust in government. if we're going to have any of this kind of intervention, it will have to be a new structure that will not be seen as a federal agency. i have concerns about how well

that would work. it is responsive. >> who appoints the members of the non-profit? >> the membership is going to provide -- representation. there are some differences between the house bill and the senate bill. it really suggests in going back to john skinner's . back in the beginning. it changes the culture of a physician behavior as a physician will see results in their hospital and their practice and began talking to each other. they will ask why they are doing this when colleagues are not. >> those studies could inform three different groups. the could inform doctors or they could inform consumers. where do you think they're likely to have the most affect? >> i think it will ultimately

have to be physicians. but i also think there has to be this sense that physicians are working together in deciding what is best for their patients , even when comparative effectiveness studies come along. one procedure has no good effects. there was a physician that said that they worship at the altar of comparative effectiveness so i am going to keep doing it. there is this total disconnect. i wonder how that surgeon will change his behavior. , together, they realize --

this, together, they realize that this is where you cannot keep spending and spending -- at that point, the internal medicine physician will start putting pressure on them and say -- and asked if you can do this better -- and ask if you can do this better. given the power to say that they are not going to pay for this. that is what congress -- congress has been very unwilling to give that power. the next section says that they will do the research, >> because that smells of a government care. >> medicare can try to do that, but it would be a disaster. you have positions telling their >> you need this, but the

government will not pay for it. >> maybe 30%, even there, the more effective mechanism is the other position sitting down with the spine surgeons saying that we cannot afford you. >> people respond to incentives. i realize that when you're dealing with a matter of life and death, making an economic decision is difficult. at-sure -- i am sure that many of us have been there. if you are on a drug that was prescribed, it may determine whether you get the generic or the brand name. >> want to come in and you were sick, you were not able to make this rational, cost effective decision. we have not been giving very economic decisions.

there is something called paid for performance. the incentives tend to be pretty small and it is not clear we are reporting better quality, we may just be a rewarding services. >> the other thing that has been important is the emerging evidence. this has been done around controlling costs. i do not want to go to the doctor and have a foot problem and the doctor not know what the best treatment is for me. i've got to have the best possible madison. -- i want to have the best possible madison -- madison --

medicine. that has not been pushed in that direction. >> if nothing else happened, and you have widespread comparative studies done by the government, how big of a difference would that make? >> not as much as you might think. you really have to -- you are asking an economist. ucla would take away my degree if i did not say that incentives really matter. >> you did not answer the question. let me ask you. what do you think of the bills that are being considered by the house and the senate? how far do they go? >> they do not go very far at all there are some interesting

ideas at the pilot level, but most of them will not be taken up. the thing that gives me some hope is that this is unsustainable. there will be pressure on the other side. unfortunately, that is the mechanism that will pressure us to face up to these health care costs. >> i find this very similar to what happens in education. it is another area where the market system does not work. you have some great pilot projects that people can point to all over the country, but they do not get adopted. there is no incentive for them to do what the best people are doing. why is that? >> i think that for institutions that try to adopt the best practices, they take a big hit.

they lose money from medicare if they keep their patients out of the hospital. >> it doesn't pay to do best practice. >> there was an article about a doctor in salt lake city that is experimenting with these things and trying to measure outcomes. he acknowledged that you take a hit financially. there are not that many people who can manage to do that. >> your analysis of why you thought that the health care bill was the right thing to do was very interesting. i hear some of the proponents and the opponents say this about the bill. you think it will take us down a step towards where we need to go. it is some sort of single payer

system. and my interpretation you correctly? >> i think that a coordinated payments system would be a good way to go. i do not think that this will bring us there. particularly since the public option is not a big part of it. the reason that i like the bill is that it will require insurance companies to be charged the same amount. i think we should have insurance charging sicker people more. i am skeptical about being able to use the leverage of purchasers the way other countries do. >> john, you made a compelling argument that as health care costs go up, inevitably, it

taxes will go up and as tax care goes up, we will get health care costs under control. how will that happen? >> it is a historical fact in other countries, but what is the mechanism? >> one thing that i think is fascinating is the acceptability of taxes in the united states. we have only taxed at the federal level at only 80% of the gdp. despite all that new government, we have tried to keep taxes fairly level. >> that has gone up and down and we have decided that we want bigger government and more taxes. >> are we inevitably headed

towards 30%? >> i have not seen the political willingness to raise taxes to that level. >> let's talk about spending. do any of you see any way that we're not going to find ourselves at something closer to 30%? >> sure, if we are spending that much, it will be cutting out of the things that we could be spending on and americans may not find that acceptable. we were successful through managed care. but that might not provide a mechanism that will allow us to manage care better. one way it is controlled premiums. we have charged people high

deductibles. there are a lot of ways we could get health care costs abouback r control. >> so, the prediction, 20 years from now, federal government spending as a percent of gdp, best guess, what would it be? >> where are we at now? >> 20. >> i think it will be between 20 and 30. public pressure will force it down. >> i think that we should open it up to questions in just a minute. if you have questions, make your way to the back. the difference is pretty

straightforward. republicans tend to have less faith in government and more faith in individuals. how do you explain the senior citizen number. these are people who are already in a government run system and probably have the most familiar to with the health care system in our society -- have the most familiarity with the health-care system and our society. >> they see their own doctors and they have a lot of choice. they do not see themselves as recipients. >> how can that be? [applause] >> well, when the medicare program was set up, it was designed to try to preserve physician autonomy. people view it that way. >> do any of you want to add to

that? all right, go ahead. >> no mention has been made about the employee employer relationship. not one time have these costs been taxable. back during world war two -- back during world war ii when there was wage price control, bregreat pressure was put on the internal revenue service, which was rather strange because if the employer paid for your food or clothing, that would all be

taxable. health care was taken out. what do you think the impact on cost would be if congress reversed the situation? >> before i answer that question, did you ever try to let the employer tax benefit? >> no, it was later incorporated in statute. it is articulated very well in the statute. >> i remember 20 years ago when congress took away some of the deduction for tnt -- t &e.

>> what do you think about that? senator mccain was calling for that and a lot of discussion about the cadillac plans. >> i totally agree with you about the cadillac plan. that is to provide a fixed dollar amount or even a tax credit. to really give in and get more of that revenue and tell firms that this is not tax deductible at all, i think he would end up being criticized because you were trying to keep this balancing act when firms continue to provide employee health insurance. if you no longer give them that benefit, many more would just

defacto public plan because so many employees would be dropped into whatever options are out there. that is the kind of balancing act they are falling. i am curious. when you were irs commissioner, you try to get rid of the tax deduction for home interest. >> there is a difference between the internal revenue service and congress. one of the things that i had to commit to back him up for confirmation was to follow the law. -- commit to back when i came up

for confirmation was to follow the law. and this is very regressive and it favors wealthier people. there are more likely to have comprehensive policies and they will have higher marginal tax rates. it is a very unfair system that we have. we do not give that to the renters. i think that there would be some mild savings, but the reason i ask that question is that there would be tremendous political opposition to taking away across the board. he was saying that you take that money and then you give everybody a tax credit to make it more fair. that seems like a reasonable way

to go. >> years ago, when hmo's were entered into the system, they were thought to deal with the incentive programs. the building would be different and the positions would see the trade-off because they were sharing in the pot of money that was being paid. is there any evidence that hmo's did this? it doesn't seem as if hmos have really changed things, fundamentally. >> i will start off, here. in the beginning, it appeared that there was something great

with hmoss. -- hmos. this is basically hmos without walls. you're going to a doctor and they are paid in a different way. you're going to a doctor and some of the patients are hmo patients and some are not. that did not work very well. people seem to favor that and there are relatively few people that stayed with it. i think that the models that we have now are not the types that have the corporate culture that has led to cost control. hmos have not really done better. their enrollment has declined

with people going to pp as. i think that the model that work is the model that is not very popular. >> this is consistently lower. that would not be a bad thing. that is the staff model where physicians are on salary. during the 1990's, they tried to expand and contract with private physicians and they were negotiating on price. if the physician did more things, they would get paid more money. it did not really work. they never really work particularly well. it is a mystery why the programs have not overtaken and swept

across the country, but i think that part of it is because that they are not necessarily pay that much more. these services can often make more money. again, the idea is that he would stick with your own doctor. they would be organized more in a default capitation structure where you paid on the basis of the number of patients in a practice. they would still see the same doctors and see -- and go to the same hospitals. >> good morning. i have been a grateful recipient of medicare and fortunately, i

have not had to call upon a very much. it is a form of socialized medicine. that is not a dirty word, nor is helping our vets. that is socialized medicine. medicaid is also socialized medicine. the point that i would like to make, and i believe i am in complete agreement with our first speaker. i was a very ignorant individual with the rest of the world's. i recently learned much and i am very grateful. i wish everybody had read the book -- everybody in congress have read the book that i am currently reading. >> what is it called? >> i am pro claim ignorance. >> is this the book by t.r. reid?

>> absolutely. it is a book that should be read by every american. i saw two very evident differences in our country and those other countries. when our doctors, and i am not a physician, but when they come out of medical school, they have a tremendous amount of debt unless they come from an extremely wealthy family. their malpractice costs are so astronomically different. in some countries, i do not even know if they have not practice. we pay far more for our pharmaceuticals than any other country in the world. i do not know why, but perhaps you can address that. my question is, do you feel that

lobbyists -- unfortunately, they were not so strong when medicare came into being. are they influencing congress will information? >> of course, lobbyists are a tremendous influence. it is inevitable. in many ways, it is beneficial in a representative kamal -- democracy. what i think is remarkable is the degree to which these issues of cost control have actually gotten on the agenda.

president obama understands this issue. this is because of researchers like john skinner who have pointed out these patterns that no one can understand. we're spending a lot more in some parts of america that other parts some people do not seem to be healthier. -- america than other parts and some people do not seem to be healthier. if enough people are pointing to it, the discourse changes. a couple of years ago, i had the privilege of giving a talk about some of this research. i talked about the need for more evidence and it was a fund talk for me but a challenging talk. some had not heard about this issue. there were a lot of positions in

the room that were resistant to the idea that there was a problem. i think that has changed. i think there has been a recognition that this is a problem. where we have a hard time is going from agenda setting to actually solving the problem. the solutions stage is where lobbyists have been most influence and that is hard to overcome. >> i wanted to follow-up on one aspect of the compromise in the senate. the other aspect is the potential for a medicare by an for ages 55 through 64. -- by in -- buy-in for ages 55 through 64.

i was wondering if that is a mechanism for potential cost control, particularly a partial substitute for the public auction -- public option. given the long term and sustainability of health care costs in the united states, i am curious as to the panel's view i am curious whether that is something that relates to issues of audiology or reform -- of ideology or for mechanisms -- or

reform mechanisms. >> i think medicare is an effective program. i like the idea of more people being able to buy into medicare. it fits into my belief a power on the buyers' side. the opposition we are seeing is the states being against this because they are saying that there hospitals are not paid enough. since medicaid pays more than private insurers, they will get less money it is also a slippery slope. it is natural that there would be concerned. i think medicare has been a very effective insurance program. i like that more people can take advantage of it. i do not think it is going anywhere. there seems to be too much opposition.

i do not think it will be the final compromise, but we will see. with regard to the employers they originally favored the clinton bill in 1993 and then changed their mind about it. you mentioned ideology. the best answer that i have is that the entrepreneurs generally do not tend to like the idea of a tremendous government involvement in anything. i defer to the others, but i think the ideology is part of it. >> we do a meeting once a year. large companies and different industries. two things were pretty clear. many of them served on various panels.

to a person, they felt like the legislation had gone in a direction that it was not born to do anything to reduce their health care costs. -- not going to do anything to reduce their health care costs. >> it is a building block. it is getting things started. >> that is a hopeful approach. >> us live from putting every doctor on salary, -- aside from putting every doctor on salary, there seems to be a recognition that incentives matter and the incentive system does not seem to be working. i think that covering the uninsured is the first issue.

i do not see -- eli >> one of the things that president obama said, he wants to be the last one to do this. that is a promise that is not going to be kept. >> particularly because it looks like it is a bill, -- if there is a bill, it will be the topic of discussion for the next panel. >> one thing you should never do is let go of the microphone. he has that and he is holding onto it. >> do employers believe that they can deal with cost control within the current system if we do not take this first step? >> no, i think there is huge

frustration. >> i am an undergraduate and my dad is one of the cardiologists that is bankrupting america right now. he had a practice in las vegas nv and he move -- he moved to lake have a saw -- he moved to california. they have to go back and look up 45 years worth of records and check every procedure he has done. now, he and other doctors are at the point where they are spending time documenting what they have done in order to avoid being sued. i will not be going into medicine and my dad has discouraged me from going into medicine. what incentives to people my

age have for going into the medical field as opposed to business or law if the best and brightest decide not to go into medicine, what does the future hold? >> with regard to that practice, the key evidence suggests that it contributes a whole lot of money. we desperately need malpractice reform, even though it will not save money. but simply because i think we are exacting a terrible toll on physicians every day when they go in to work because they do not know it today as the day they will get sued for something -- today is the day

they will get sued for something that they did not case -- cause. they will get sued as a consequence and the jury will take pity on this poor individual and award lots of money to them. the implication is that the physician did something wrong when they might not have done something wrong. one of the real interesting puzzles is why malpractice reform is an on the table as a way to get the republican side of congress on board. >> what is the answer to that? >> it is partisan politics. i think it is that partisan politics. -- bad partisan politics. >> partisan politics because trial lawyers are loyal supporters of republicans?

>> exactly. the public is particularly worried about the current malpractice system. 78% of the public that we interviewed agreed that doctors would do this even if another treatment option was better. once the studies are there, the doctor will have to follow them or be sued. >> we are going to have to limit it to one more question. >> the german system was praised by date and by some of you. the german system is a complete mess. it is a two-tier system.

it is a public insurance system but it is policy driven. it is paid out by payroll contributions and state subsidies. it may be right that there is a [unintelligible] nevertheless, in germany, we've pay more for pharmaceuticals than what you buy in italy. all that works is good incentives. we are not -- we are also rethinking it. what about a system -- a mixed system between a public system and a private system with the public system at the bottom covering the public good witches in help -- the public good,

which is in health services. for everybody, based on risk aversion or not. whatever you like. maybe both work together very well so that if you follow the discussion, your surprised about the views. >> is the danger there that the healthy people opt out of the public system and move into the private system? >> the danger is it will become like medicaid. fewer people seem to be opposing that we move medicaid up then we move medicare down -- thean we

move medicare down. many of those that boat are in favor of medicare. in -- with medicaid, there are probably fewer voters. >> i kind of like the mixture of having germany. they always feel it is a horrible system. they have been engaged in constant reform. it was a good system and it is still a good system di. that is actually a very nice match. in the u.s., where 20% of the people in medicaid pay for 40% of the births.

90 percent of the public system and 10% in the private system, that works for me. >> americans believe that doctors can do anything. >> that is next. >>[applause] >> we will take a 15 minute break and then we will return and talk about making policy.

>> coming next on c-span, america and the courts but two interviews. following that, a look at 2010' s senate races and pulling. >> tomorrow, on washington journal, flint levirate, charlie cook and stu rothenberg and the daniel erickson. washington journal, live at 7:00 a.m. eastern on c-span. >> this week ron baxter od bexts

guses internet corporation for assigned names and numbers. >> fox news contributor michelle malkin is our guest. she takes your calls, emails and tweets.

>> this is see spsusc-span's america and the courts. justice souter is interviewed. >> we're in the office of the clerk of the court. where have you been today? >> 1 justice announced both of them we spoke about attorneys and the members of the bar that

were sworn in. today was a ceremonial day. >> this is the morning coat. it is a very traditional outfit. here at the court, it is one by the marshall of the court and myself and also the solicitor general of the united states and his staff. some of the women on his staff do not wear the morning coat. hear, our marshall is a woman and she wears the morning coat. we traditionally where the morning coat when we are in session upstairs and at the inauguration of the president. it is very traditional. attorneys were traditional attire. >> do you know how far back that is? >> .

>> do you know why it is called the morning kercoat? i do not. >> can you turn around so we can see the back of the jacket? >> recall what a morning coat, but is it the whole suit? >> it ism m-o-r-n-i-n-g-. >> this is your normal attire. >> what would your normal day be like? what are your duties? >> that are basically responsible for the business of the court.

it interfaces with the public and members of the bar that are filing documents. my office meets them and receive documents and analyzed them and enters them on the electronic bucket. then, we do with the attorneys on setting up the argument dates and maintaining all the legal documents for the court. >> what is the hardest part of this job. it is a great job. it is an honor to work at the supreme court. after all of the years i had in the military, i missed leaving the army because of the camaraderie, but i felt the same

thing here. this is a small organization. no politics. justices are appointed for life. there is no civil service system. the people here are the best qualified. and instead of just having jobs, employees here have a sense of mission. it is really a high calling. so we look at it more as a calling that a job. i do not find it hard. if the justices need something, if something needs to be done, we provide it. for the clerk's office, there are only 32, mostly paralegals. they're highly skilled individuals. >> if we would see them working out, what would we think? >> the men and women working there are doing many things. they are highly automated here at the court, but you have to

have a lot of hard copy documents. we have eliminated much of that. the other side files a brief and opposition. those documents have to be maintained in an orderly fashion, transported to the justice's chambers to be worked on, returned, and documents that are used are recycled and so forth. so we have a real system for everything that enters this court. >> how often do private citizens have cases in front of this court? >> we have about 8000 petitions asking this court to hear the case. there are very few mandatory appeals. it is basically jurisdiction. about 2000 of the cases are

filed by lawyers who know what they're doing, law firms, or state entities. they are printed and they have to pay a fee. we have about six dozen individuals who are poor. about half of them are in prison, and they under lock and file a petition asking the court to hear their case. outside this building, it's as equal justice under law, and we really believe that. some might be frivolous, but they are looked at carefully. so sometimes you have people called the jail house attorneys.

adoption or child custody or income tax, anyone could file a document. some are written by prisoners on prison stationery. one case was granted and heard that way, and a very important decision resulted in the case. they are not skilled, but they can try at it, and they feel better. our job is to make it as easy as we can for a person to file a document here. the rules of the court are written in plain english so they can be understood, posted on our website. we want to make it as easy as possible. >> this was highly automated.

>> it has been an enlightening time to be here, because you are all over the place. the memos are written by the law clerks. everything is on line. we never hear that the computers are down around here. it just does happen. >> how do you combine automation and tradition? >> we thrive on discipline, and those things are hand in hand. one part of tradition is when an attorney goes into the courtroom in the morning, i brief them before they go in there so they know what to

expect, to put on a tie or a shoe, especially the rookies are sometimes forgetful. . . when an attorney a purchased the bench, he says mr. chief justice, and will it please the court. everyone gets 30 minutes, not 31 minutes. it is part of tradition, but it is also discipline. >> let's say you are walking into the lawyer's lounge today. >> the attorneys are instructed to be there at 9:15 in the morning. regulars all know to be there.

sometimes they do not know each other. you do not know your opponent. this is a national court. they want to get everything they need, aspirin, cough drops, to make them comfortable. and the feedback i've gotten over the years is that they liked it very much. the solicitor general, her and her staff are here so frequently. for example, when chief justice roberts was the deputy

solicitor general 18 years ago, he did not attend the briefings. when he left office, he attended the briefing. he has told me cents, he liked the briefings. he wanted me to continue. it was therapeutic. and i am just sitting out my hallway, going over last-minute requirements, and we like to enter the courtroom prepared and ready for both sides of an equal chance winning the case. so we do not take sides. >> do you go on a little bit of counseling, and a little nervous about this day in their lives? >> yes, but to speak to them privately sometimes about not to worry, do not be nervous. those that are nervous need a whole box of cough drops, we will give them a whole box.

if it makes them feel better. sometimes they need a glass of water. we are there to make sure they feel better, and the lawyers do a tremendous job. there are three tickets to successful advocacy. preparation, preparation, preparation. and some council are so good they appear and argue with no notes, no cards, no anything. i do not recommend out, but some are highly experienced and they do about. >> do you have a conversation with them prior to arrival? >> on some occasions. but i have someone who wants the case is granted, you deal with her. she sends you a care package, all the documents you need, here is your phone number, your e-mail, so they do not hear

everything third hand. they get to know each other. and the bottom line is, their word is good. whatever the state, you go to the bank on it. very sophisticated. they're the best. >> so if you walk into these chambers, what do you do? >> i make sure that the attorneys are at the right table, respondents on one side, checked to see if there's anything you need. i then talked to the people making motions for admission. make sure they know what to do, where to stand, went to speak, and those that have been sworn in are briefed on what they are supposed to do. they did not want to come to the highest court in the land and stand-up for service. they need to explain what is

required. so i generally check around to make sure we're ready to go and it 10:00, we start. never late. never. >> a lot of people are doing a lot of work, getting the lawyers in to make sure they are seated, all the spectators, and everyone is in there. the press is even there on time, believe it or not. everything is orderly and respectful. there's a five minute buzzer, and that means five minutes, away we go. they enter on groups of three. the traditional cry is used throughout the country to announce the arrival of the court. the justices enter, take their seats, everyone rises, and it is an inspirational moment. everyone says, i cannot believe it, they are really there. it is not a broadway

production, but it makes the hair on the back of your next day up a little, because this is really it. it is very orderly, very respectful, and a grand moment for everyone up there. >> how does the business then proceed? who is involved? >> normally, the chief will save motions for admissions first, maybe an opinion coming down, and then they will hear argument for smith versus jones, mr. chief justice, may it please the court. they know where to stand. no one is winding around. everyone knows what to do. the chief justice has a script, and even names of ernie's are spelled phonetically so he can get the right name.

you do not want to make any mistake. >> and that is the last time you have any control, right? >> they're out of the gate. at that time, it is too late. they know what to do. they want to get on with it. sometimes, the council would rather go first and second. but that is the way it is. sometimes you'll get up and leave the room for a minute to take a stretch or something, but they have to be back at 11:00, when we start our case. i am their court needs anything. sometimes i need another document, were they will tell council to follow up and submit that to the court, and otherwise, just be there to assist the court on anything

that might be needed. strange things might happen. the council meets another document or something. but again, it is a good tradition. as you face the court on the far left, the marshall is on the far right. you reach out and shake hands of the next justices. it is a good part. i listened to the argument, but i am more attentive to those i am interested in, so i've witnessed about 1300 arguments since i have been here, seen a lot of good lawyering, and a lot of good lawyering from the justices. ask a lot of questions. a journalist who is a friend of mine has covered this court for 50 years, and he thinks this is the best prepared court as far as the justices being up to speed on the case and asking penetrating questions, the best that he has ever seen. and a couple of cases last term, in one case they asked 102 questions, and another, 106.

in one hour, that is why the council has to be very well- prepared. >> so tell me a bit more about your interaction between the justices and you. >> i deal more with the chief justice than any others, and i deal with the junior justice every week after the conference. he takes the notes. and when we're finished, i go to other staff members, sit down, and he tells us what happened at the conference. we are going to call for the views of the solicitor general in this case, and so forth. we then returned to our office, double check everything, and prepare the orders for report which have been released for next monday.

the orders for the court are certified and found. they are then released, they go on the internet, pull the information, and all of the people interested can join us, they know what cases will be heard. >> and when you get that briefing, do you know what happened in terms of the discussion? >> no. we just get the results. it takes a few minutes. they are very good at it. so that is another tradition, that the junior justice takes the notes. >> sitting back in a courtroom, in the chambers, tell us from your vantage point what you see? >> i have got to tell you, i

still am awed by the building and the institution. i was a lawyer for about 30 years, a lawyer here doing legal, administrative, and clerical work. but i sit there and think that the disputes that are settled in the courtroom rather than in the streets would be illegal, and within the building, all of the landmark cases and cases that are not landmark, they are important to someone out there. a bankruptcy case is not something that gets me to excited, but it is important to someone, and to the legal community. so i take it seriously every time. it is never old hat. it just is not.

to me, i think a lot lawyers and other people are supposed to feel the same way. you are in that room, and it is very, very important. >> when you are sitting there, is there some peace, architecturally, or just something in that court that draws your attention, or has over the years? >> the ceiling. i have never seen that thing before. i saw some in new york a few years ago that look like ours. you do not see them. they are on the elevator doors, all over the building. nothing in particular in mind. he liked them just as much as i like them. they are just beautiful. >> as you continue to look around the room, what represents the tradition of the court? >> the robes. the robe is a mark of anonymity, and that is what they

really are. they are people who interpret law, and do it fairly, without political persuasion. we do not have secret courts in this country. citizens can come in and watch the case if they want to. i am glad insole open, that we are all there, a hearing the case argued in public. bush versus gore, hundreds of people work here, and a dark to hear everything the court said, and the court had to return and make a decision. it is democracy at its best. >> the oral argument.

what do you see? >> i think i see the greatest people on earth. i think this is the greatest country on earth, and those here on vacation with children or school groups or anybody here, some might not fully understand what is going on up there, but they are at least there to see that this is the court of last resort. this is not my building. the justices work for the people. the do the people's work, and we are all there watching it. and the parties that are involved are here. hospital groups, student groups, law students. it is great to see america across the spectrum, all types there. i have spoken to about 1300

since i came here. so yes, two or three a week. boy scouts, girl scouts, students from all over the united states. many are repeaters. in the united kingdom, where rugby was invented. lots and lots of students, very interesting, and they had questions, the high-school students telling them about cases here with children of all age. i will tell them, let them vote, see who wins. and the justices do a lot of public speaking. >> do you get unusual questions with those kids? >> yes. >> anything you want to share with us? >> not really.

>> the history of your office. tell us a little bit about that. >> the pope was the first person appointed here in 1790. mr. tucker, focused behind me. they did not do a lot of business, because the court did not know exactly what it was supposed to do, and those framing the constitution thought it was a good idea to focus more on the other two bridges of the government, rather than a third branch, as we are called. they say mr. tucker, i've got some documents. but they are getting organized. when i came here, i said i've got to last longer than he does. so the clerks have taken notes and written things.

i know a lot about the history, and i have been gathering a lot of information in front of me, and i would like to compile some sort of historical document when i retire about all the clerks. there are interesting stories. there have been 19. >> are a couple of the 19 jumping out you? >> yes. mr. browning left here and was appointed to the ninth circuit court of appeals, and he is still there as a senior justice. i believe -- he was the last clerk to hold the bible. and then there was kennedy. so i have met mr. browning. a delightful fellow. and on about five of the previous clerks. interesting people, and each one is a little different.

i am the first military person. >> are there any artifacts from the early days? >> yes, there is a roll-top desk on my right, and i have a display beneath the portrait, so if they want to use it, he can come back and use the desk. >> i want to ask you about or military background. >> i was a major general. >> what was it that prepared you for a job like this? >> a career. i took my basic training in fort hood, texas, at rotc. coming out of law school, i enjoyed it. my wife enjoyed it. we lived around the world.

bangkok, vietnam. many assignments in different places. each time, there are different challenges, and i enjoy it all. i felt personally like i was getting ready to come here for this job. it is interesting, because we have places and things to get done here, and we got those things done, and having time and money prepared me for what work would be, getting things done. you are dealing with people and things. and it is the same thing here. >> what is your favorite part of

this building? >> this office. it is very comfortable. it's a great place to work and keep visitors. i am very big on delegating authority to everyone else to make decisions, but for instance, the law clerks, i see them, men and women who are dedicated and bright. but they will see whatever person or deputy is responsible for that area, e-mail them, call them by phone. they do not have to see me. so not all of them. >> do you remember your first as clerk? >> yes. i was clueless. i put on the air that i knew what i was doing.

i walked around. be careful about making changes to quickly, and be careful about what you believe. just take it easy. i had interviews with all of the justices, and it was very interesting to me to come in and talk to those important people. the budget was fine. little by little, we got moving. i wore one of my brand new suits that day, also. >> [inaudible] >> i did not remember the name of it. >> had you ever visited the court as a kid? >> yes. i would come here as an army officer to your military cases. several times, i came over and

hurt cases we have a great interest in. you want to see the argument. you want to see the interaction that goes on, because you are interested in it. i was admitted to practice here. i had some friends that worked over here. i was always lost. >> and you have not been made yourself before? >> no. >> tell me about what people see when they do that, and what some of those things mean to you. >> when they are walking up the steps to argue a case? >> or when you visit as a tourist. >> as a tourist, i think you see it as a monument, not just to the judiciary, to america. this is not just a courthouse.

we make decisions that affect all of us. you see this as a place where laws are not made, laws are interpreted. those walking up the steps to argue a case do not see anything or hear anything, even those with a lot of experience. they have to. but they are very good. i wish all my students in this country would come here and see an argument. it is just wonderful, seeing it all played out in front of everybody. >> what is your for your part? >> the columns are what you can see the most. >> what do you make the most different in your job? >> hiring and training of staff. it takes a lot of work from a lot of people. maintaining them, taking care of them, supporting them, making sure that they are loyal

to the institution, which they are, but that is very important. if you do not have a good staff -- you will have a law clerk with a staff that is not good, you will not have a good office. that is one of my main jobs. >> thank you. >> thank you. thank you for coming. >> you are watching c-span's "america and the courts." we continue with our encore presentations from c-span's supreme court week, with the construction of the current supreme court building. >> this is the last new classical building built in america. it was built in the 1920's and

1930's. the architect got money for it, and it is a very attractive building. has become the symbol of the supreme court. one of the justices who did a lot of work on it did not want to leave the former chambers, the basis of the senate. he said if we leave these offices in the senate, no one will ever hear of us again. but he was wrong. brandeis said he would not come in here, because this building is so elaborate. and he was right. but over time it has become a symbol of the third branch of

government, and the need for stability and rule of law, which is what america stands for. >> the building was opened in 1935. before moving here, the justices met in different chambers in the capital. first we hear from jim o'hara about the stories and characters behind to move to get the court its own home. >> chief justice taft was the dynamic force that made the supreme court building possible. he was a former president of the united states. he is the only president who ever served on the supreme court. there are a few earlier presidents, but none ever served. he was determined that the supreme court should not be an afterthought. it was working out of rooms that were very, very constricted in the capitol building. the courtroom itself was a

former senate chambers. for some purposes, they would have to borrow things from the senate. the justices' library was the old chambers in the basement. the court should have a place of its own. it was a branch of government, and he forced to that issue. he forced that issue. some other justices did not agree with it. but he forced the issue. >> it now seems so obvious as you look at the white house, the capital, it seems that people assume it has been there forever. why wasn't it? >> early on, when washington was being billed, they actually mentioned there should be a hall of justice for the supreme court, but it was never built. using the capital for storage, there was no conference room

there. they met on wednesdays, when the senate did not meet, to discuss cases. and justices worked out of their homes. they would have messengers who would go from one justice's house to another house with a draft of opinions. i think sometimes that if any of those justices have known that sometimes the messengers were just riding the streetcar, if they have lost the case, that had gotten out, somebody could have made a killing on the stock market knowing what the court was going to do in advance. but that never happened. and some of the justices were happy with that arrangement. they could come to the capital when a case was being heard.

>> taft himself, it sounds like there was resistance to getting a supreme court building built itself. did it take someone like him, or could anybody have got in that building off the ground? >> i do not know if someone else could have ever done what he did to build that building. i do not know the answer. maybe another chief justice who was fixated on the building could have pulled it off. but the fact is, taft was the 10th or 11th chief justice, and none before had been able to do it, even though they were hiding respective figures and he had be chief justice for a long time. i suppose there was a time

justices were happy with that arrangement because many of them did not live close to the capitol building, so living close to it was not an easy thing. and many justices lived relatively close. all lot lived around connecticut avenue or near dupont circle. but taft had in mind that the court needed a building of its own. he believed that when he was president and when he became chief justice, it became almost an obsession. >> how much was he involved in the actual design of the building, the fact that went into what was left? >> he was interested in that building to such an extent that when he initially went to congress, to the appropriate

committees of congress, to ask for the money, taft immediately ran into a little problem in that the architect of the capital wanted to have [inaudible], and taft thought that the legislation would make him chairman of the commission. taft and one of the other justices were on the commission. the architect was arnold tool, but taft controlled the commission because he was friendly with the appropriate chairman of the committees in the house and senate, the teacher that other members would be members of the house and senate. so he was responsible for choosing the architect. he liked the architect chosen. he said of all the architects in america, this was the one to

build the building. and the architect actually had sketches that were done years before he officially got that job. just thinking that if you are going to describe the job, maybe he can do some ideas or whatnot. >> the supreme court has that classical look to it. a tie-in to ancient roman times. but that was against the grain of what was going on in america at the time in terms of architecture. so was there some kind of fight these guys have to go through to get something like that built? >> architect and chief justice taft both felt the building should reflect jefferson's the original idea for the capital. jefferson was a great admirer of greek and roman architecture.

jefferson's concept of the capital city was a city that would remind people of ancient rome or athens. and the architect of the supreme court was very, very comfortable with that idea. although modern architecture reflected people like frank lloyd wright, who would have done something very different, i think that gilbert and have felt jefferson's idea, better than a school of architecture that might have ended up just being a fad. >> it is a little bit more than $10 million. >> it was actually a deflation. they were able to finish it and turn $100,000 over, so it came in under budget.

it might have been the only government building in history that came in under budget. he was thoroughly familiar with the plants, and i think he died quite happy with the building that he knew was going to be built. he and the architect, cass gilbert, they corresponded regularly. and when taft was president, he had appointed gilbert to a fine

arts commission at the capitol. so gilbert knew what it was about, and he knew what visions jefferson had had. some of the justices did not like it hurt much. some continued to work out of their homes, happy with that arrangement. of course they came to the building for hearing cases the chief justice at that time was charles evans hughes, and the

office they provided for him and the building was more as a ceremonial office to greet distinguished visitors and so forth, and he continued working out of his home. most justices at the time did not even claim the office space. the first justice who used that building extensively as his office was hubert block, roosevelt's first appointee, appointed after the building was completed. supreme court justices are not shy, and some felt that the new building was to grant, too grandiose. later, chief justice stone, he was an associate justice when the building was built, and alleged to say that he thought the justices were like nine

black beetles, and they should write in each morning on elephants. he also made the comment that the building was for nine old guys on the supreme court. the other thing about the building, aside from the fact that it had an awful lot of marble in it, which the justices were not accustomed to, the building was very large. they thought that like many other buildings, they recognized it is a corporate world. so a lot of space was there, and justices who came to the

court felt that there was a lot of wasted space, and of course, i think that both taft and gilbert proved to be correct, because the same building was used for the court, and of course there were still nine justices. the office has grown, and the number of cases has grown exponentially in terms of the cases the court is asked to hear, and there has to be a place for storage. now that the building is properly bursting at its steams, it surely is not too large for present activities. >> so it must have been a bit lonely over there.

>> just as pat probably felt all little awkward when he came in, but as you recall, after black was appointed, president roosevelt had a lot of appointments in a bill to the short time. that was almost immediately drawn by justice read for appointments, and he was in the middle of another put appointment with frankfurter and douglas and burns. so in a short time, he was joined by lots of other appointees, and they all use the offices we provided for them

in the building. justice brandeis never moved into the building. he was perfectly capable, perfectly happy with working in his home. of course, justice brandeis, for all of his superb mental abilities and superb legal mind, was a very gentle, simple man, and maybe thought the building was not the kind of building he could write his opinions in and feel at home. so he never moved in. >> he was opposed to the court building you were covering in this program. he felt that the plans were excessively grand, he liked the chambers that existed in the capitol building, he told that the buildings, the new proposed building would not contribute to the justices' humility, which they needed. >> frank gill byrd is the

grandson of supreme court justice louis brandeis. he sat down with us to talk about his grandfather's time on the supreme court and his reasons for the opposition to the court's new home. >> my grandfather declined to use the chamber's in the new building. in fact, he never set foot inside the chambers, continuing to work at home in his apartment. and i'm told the staff used the building in the 1930's to point out what the offices will look like. the grandfather did not need all of that space. the efficiency apartment where he worked was quite modest.

but back at home, he had law books spread out on the floor of his office, and it was not a big home. but that served. he saw no need for this model palace. he had very good relations with his fellow justices. they all used the building. one clerk told me years later that one of his fellow justices raised objection about the building. and the grandfather turned to the law clerk and said, well, he voted for it. that is not typical. but he obviously had strong feelings against the building has been to grant.

he did not say anything. people got the notion he did not approve of it. but he would not speak out. he would just cast his vote against the plans. i would add my grandmother, beyond grandfather, had a curiosity about what the suite of offices looked like, so she went over to inspect them, and as she left, she said the rooms have two things my husband never uses. one is the shower, and the other was a tap for ice water. in those days, the people were given a cap from which they could get ice water. the grandfather did not use ice water and not use a shower. >> to do you have any thoughts about the court ruling itself, compared to the supreme court chamber inside the capitol? >> he argued in the capitol

building, it was fair to describe as an imminent chamber. he was a successful advocate for the supreme court before he became a justice, very comfortable in that building. and in the old chambers, he argued a case on the rights of the state of oregon to limit the powers of women working in a laundry or other industrial use in oregon. the case was miller versus oregon, and its stance for the principle but grants what was demonstrated in that case, to bring in outside evidence of what was going on in the world.

so a number of legal precedents were cited, and the supreme court was presented 100 pages from all over the country and world about the importance of reasonable ballots for a wound. and that was in the chamber that it was submitted to the supreme court. >> interesting story about your mother. one of the first women to argue a case. tell us about that. >> my mother, in new york city in the 1920's bus, came at the appeals level and did it on behalf of a lawyer find for charging, for overcharging it representative of the family who was deceased. congress had given benefits,

but placed a very low limit on what the lawyer for the veterans' family could charge. so on appeal, a mother argued and lost. grandfather did not sit the case, naturally, but i know that he was proud of my mother when she argued this case before the supreme court. >> as a jewish person, did your grandfather ever talk about sort of the -- either the pride that he had at being the first jewish supreme court justice, with the challenges that may have come along with that? >> grandfather was indeed very proud of his jewish heritage. who was going in this country, the son of people who had come over, 1848, come over from prague. he was very proud of his jewish

heritage, an early end committed zionist who felt deeply about the homeland for the jewish people, and he worked very hard to achieve what is now the state of israel. and it is well known that grandfather faced anti-semitism on the supreme court. one fellow justice would leave the room when he was speaking at conferences held by the justices to decide the case. so justice mcreynolds served on the court with grandfather and he did not treat him politely, nor did he treat politely justice cardozo when he was appointed to the court, and he served for a couple of years before a transfer and showed anti semitism. >> how did your grandfather deal with that?

>> i think he just -- in terms of justice mcreynolds, i think he just went forth and did his work. with his resignation, as was customary, the chief justice wrote a letter to the retired justice to praise him and indicate how much the court would miss him. and after chief justice hughes drafted this letter, the senior justice declined to sign the letter. the other justices immediately signed the letter, sent off to grandfather as an indication of how justice mcreynolds stood by my grandfather, but he did not

need the signature. he wanted to stand by others indicating respect and affection for my grandfather. >> did he understand the path that he was blazing, the precedent that he was setting? >> as a justice, again, he was very conscious of his jewish heritage. and in a quiet way, he was very proud of it. he certainly was one of the first jewish justices. that was not central during the nomination battle. it was a very long battle in 1916. today, it is commonplace, but in those days, you would go for many years without an argument about the nomination of the justice. so there was some anti-semitism

underground at the time the senate was considering this nomination. >> at this point, you were between six and 10 years old. is this anything that affected you? >> this was a terrible time with hitler rising in germany. grandfather was very concerned about the fate of the jews in europe and he was very concerned when the british issued a white paper which limited immigration to what is now israel by jews trying to escape hitler. the british issued the white paper. they were in charge of remanding.

i remember after all these years is anger. even though i was very young, i remember his words, "the british have lost their ability to rule." that was his response to the british cutting off the avenue of escape to palestine, what was then palestine, for the jews in europe. >> what was his relationship with chief justice taft? >> they had a good relationship, and they saw things differently, and indeed, chief justice taft has a private citizen had been one of the former presidents of the american bar association who opposed grandfathers' confirmation as a supreme court justice. that was in the teens. before that was over, william

howard taft came up to grandfather, ran into him in washington and said, "i have done you an injustice." then a few years later, chief justice taft joined the court and they served together many years on the court. >> they had a good relationship? >> they had a good relationship, and justice taft opposed his nomination to the court, but then said he had done him an injustice. i am very much moved by the role of the supreme court, and i must say i am very proud on these issues that grandfather was identified with with his thoughts, the validity many years after he wrote them. and the whole picture, you think of the distinguished men who have served there and how dedicated they are, and frankly

how these justices do their own work. >> watch both of these encore presentations again or quit -- or get more information at the website. or go to c-span.org and click on supreme court. join us next week, saturday evening at 7:00 eastern on c- span. >> in his weekly online address, president obama talks about the connection between an al qaeda group and the attempted christmas day terrorist bombing of a u.s. bound jet and has pledged to work with the international committee to combat terrorism. that is followed by the republican addressed by mitch mcconnell the talks about domestic and foreign policy challenges that lie ahead for the nation and the need for

elected leaders to come together to solve these problems. but >> it has been more than a week since the attempted act of terrorism aboard the flight on christmas day. thursday, i received the preliminary findings of the review that i ordered into the terrorist watch list system and air travel screening. i have directed my comments security adviser at the white house to lead these reviews going forward and present the final results and recommendations to meet in the days to come. as i said this week, i will do everything in my power to make sure our hard-working men and women in our intelligence, law enforcement, and homeland security committees have the tools and resources they need to keep america safe. this includes making sure that these communities and people in them are coordinating effectively and are held accountable. as president, that is what i will do. the investigation into the christmas day incident continues and we're learning more about the suspect. we know he traveled to yemen, a country grappling with poverty

and deadly insurgencies. that appears he joined a fleet of al qaeda and they trained him, a coke him with explosives, and directed him to attack the airplane headed for america. this is not the first time this group has targeted us. they have bombed yemen government facilities, restaurants, and embassies, including our embassy in 2008. as president, have made it a priority to strengthen our partnership with the yemen government, sharing intelligence, working with them to strike al qaeda terrorists. even before christmas day, we have seen the results. training camps have been struck, leaders in ltd., plots disrupted. all of those involved in the attempted act of terrorism must know that you will be held to account. these are only part of the wider cause. it has been almost a year since

i took the oath of office. with that came to some responsibility that i carry with me every moment of every day, irresponsibility to pick the safety and security of the american people -- a responsibility to protect the safety and security of the american people. we will do whatever it takes to defeat them and defend our country, even as we uphold the values that have always distinguished american among nations. make no mistake, that is what would he have been doing. we have focused the fight and are bringing it responsible and to the war in iraq that has nothing to do with the 9/11 attacks and increasing resources in a region where al qaeda is based, afghanistan and pakistan. that is why i have sent a clear and achievable mission to disrupt, dismantle and destroy al qaeda. that is why we have forged new partnerships and have put unrelenting pressure on these extremists were for the plot and

train. from east africa to southeast asia, from europe to the persian gulf. though often out of sight, our progress has been unmistakable. along with our partners, we have disrupted financing, cut off recruiting chance, but did major losses on their leadership, for plots and the united states, and saved countless american lives. as the christmas day attempt illustrates, as we were reminded sweep of the sacrifices of more brave americans and afghanistan, including the 7 dedicated men and women of the cia, the hard work of protecting the nation is never done. as we continue, let's ask the questions that need to be asked. let's make the changes that need to be made. let's debate the best way to protect the country that we all love. that is the right and responsibility of every american and every elected official. as we look forward, remember this, our adversaries are those who attack our country, not our fellow americans, not each other.

let us never forget what has always carried us through times of trial, including those attacks eight septembers ago. instead of giving in to fear and cynicism, let's renew the timeless american spirit of resolve to and confidence and optimism. instead of succumbing to partnership -- partisanship and fishing, let's work together. let's do what must be done to keep our country safe. we begin this new year, i cannot imagine a more fitting resolution to guide us as a people and nation. happy new year. >> the new year always brings with it renewed hope and a spirit of optimism qualities that have exemplified our nation and its people from the very start. one such moment that stands out took place on this very day in 1777, along the new jersey- 1777, along the new jersey- pennsylvania borde